- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $704.33 / $704.33 / $4,828.00
| Facility | | $704.33 | $704.33 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,509.28 / $4,320.60 / $7,808.13
| Facility | | $2,509.28 | $4,320.60 | $7,808.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,739.22 / $2,467.69 / $5,936.39
| Facility | | $1,739.22 | $2,467.69 | $5,936.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,581.11 / $2,256.07 / $4,674.33
| Facility | | $1,581.11 | $2,256.07 | $4,674.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.00 / $1,232.34 / $4,708.43
| Facility | | $741.00 | $1,232.34 | $4,708.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |